October 2019

NEWS

Presentation SpotlightAre physicians burning out?

by Stefanie Petrou Binder, MD EyeWorld Contributing Writer

Understanding the factors that contribute to burnout among physicians is not only important for a physician’s personal and professional well-being but it allows them to take measures to correct the problem and provide the best possible patient care. A new survey conducted at the Medical University of South Carolina (MUSC) determined and compared the prevalence and characteristics of burnout among ophthalmology residents and attending physicians within a single institution. It revealed that more than 40% of the number of currently active residents and university faculty members met the criteria for burnout.

Institutional review of burnout

Sudeep Das, MD, first author of the e-poster, “Prevalence and Characteristics of Burnout Among Residents Versus Practicing Ophthalmologists, An Institutional Review” shown at the 2019 ASCRS ASOA Annual Meeting, implemented the Maslach Burnout Inventory to determine the prevalence, components, and severity of burnout among residents and practicing ophthalmologists. Dr. Das and coauthor Rupal Trivedi, MD, defined burnout as a mental and physical state of exhaustion and described it as having three components: emotional exhaustion, depersonalization or cynicism, and a low sense of personal achievement.
His survey revealed that residents trended toward higher depersonalization while faculty trended toward higher emotional exhaustion at MUSC. Physician burnout is a warning sign that can be associated with poor patient care, decreased job satisfaction, depression, and suicidal ideation, with important implications for the wellness of both patients and healthcare providers. A literature review on burnout experienced in residency training programs from 1974–2009 noted burnout in 27–75% of residents depending on their specialty and recommended the incorporation of instruction and interventions for resident physicians.1

Scope of the problem

Burnout among physicians needs to be taken seriously. According to the literature, all medical specialties have more burnout than the general population. Ophthalmology, specifically, demonstrated burnout rates of between 40–50% among specialists over the last 6 years.2 Evidence suggests that burnout is considered to be more of a systemic or organizational problem rather than an issue that stems from the individual physician.3
There is little to no data regarding the rates of burnout among ophthalmologists in academics vs. those in private practice, as well as a lack of studies looking at burnout at various levels of training. Comparing burnout between residents and attendings within the same institution might shed light on its sources.

Burnout survey

The Maslach Burnout Inventory – Human Services Survey, a 22-question, validated questionnaire, was sent to all MUSC residents (n=12) and academic faculty (n=12). Dr. Das collected the responses anonymously, analyzed data with SPSS Statistics software, and compared averages to normative data of more than 11,000 healthcare workers.
Clinically significant burnout is defined as high scores in emotional exhaustion (EE), depersonalization (DP), or both. The survey showed that 42% of both faculty and residents met criteria for burnout with residents trending toward higher depersonalization and faculty trending toward higher emotional exhaustion.
In 58% of residents and faculty, there was no significant EE or DP. In 25% of both groups, there was high EE and DP. High DP was noted in 17% of residents and high EE was noted in 17% of the faculty.
“The overall rates of emotional exhaustion were comparable among faculty, residents, and average healthcare workers,” Dr. Das said. “Faculty trended toward lower levels of depersonalization compared to residents and average healthcare workers. Residents and faculty each had significantly higher levels of personal achievement compared to the average worker in healthcare.”
The rate of faculty burnout (42%) in the survey was comparable to specialty-specific data published by the Mayo Clinic in a study on executive leadership and physician well-being.3 The rate of resident burnout (42%) in the survey appeared lower than rates of burnout within ophthalmology residency (66%), according to data currently being prepared for manuscript submission. Overall, MUSC physicians appeared to be doing as well or better than national averages for levels of burnout.
The study authors suggested that the trend toward higher levels of emotional exhaustion in faculty may result from less inherent control in the academic setting and that the trend toward higher levels of depersonalization among residents may result from the rigors of a learning environment that detracts from patient care. Significantly increased levels of personal achievement could result from an academic environment in which achievement is more objectively measured.
“The similarities between rates of burnout for faculty and residents within the same institution suggest that there may be systemic factors that are protective or increase risk. More data is necessary to assess if similar findings hold true at other institutions. Additional studies are needed to determine what specific institutional factors are most influential with respect to burnout,” Dr. Das said.